James Carol Wagner

NPI #1912597139 in Dunlap, Illinois

Provider Information

NPI Number: 1912597139
Entity Type: Individual
Name: James Carol Wagner
Gender: Not Specified
Sole Proprietor: Yes
Primary Specialty: Behavior Technician
Enumeration Date: Jan 21, 2021
Last Updated: Jan 22, 2021

Practice Location

Address: 111 HICKORY ST
City: Dunlap
State: Illinois
ZIP Code: 61525-9703
Phone: (309) 357-1973

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Behavior Technician	106S00000X	Primary

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